Quality Improvement And Patient Safety

Objectives:

In this exercise, you and your nurse colleagues will select a specific population, state an aim, and select a set of outcomes/cost measures. In essence, you will identify measures of outcomes that contribute to the value of care. The final step is to name, define and operationalize the selected outcomes/measures. Complete the Clinical Value Compass to identify measures of outcomes/costs that contribute most to the value of care. For example:

Outcomes: Patients with confirmed acute MI, direct admits only, from time of admission to Emergency Department to 8 weeks post discharge.
Aim: To find ways to continually improve the quality and value of care for acute MI patients.
Value: ….
Instructions:

Using the Clinical Value Compass Worksheet, (ATTACHED) create a document where you fill out outcomes, aim, value, and operational definitions.Clinical Value Compass Worksheet, Side A

OUTCOMES Select a population (specify patient population)

AIM What’s the general aim? Given our wish to limit or reduce the illness burden for “this type” of patient, what are the desired results?

TIPS: Path Forward

Worksheet purpose: To identify measures of outcomes/costs that contribute most to the value of care.

1. Select a clinically significant population.

2. Assemble small interdisciplinary team.

3. Use brainstorming or nominal group technique to generate “long” list of measures

4. Start with west (clinical) on the compass and go clockwise around the compass.

5. Use multivoting to identify “short” list of 4 to 12 key measures of outcomes and costs.

6. Determine what data are needed versus what data can be obtained in real time at affordable cost.

7. Use side B of worksheet to record names and definitions of selected measures of value.

VALUE Select starter set of outcomes/cost measures

Functional Physical function Mental health Social/Role Other (eg, pain, health risk

Clinical Mortality Morbidity Complications

Satisfaction Health care delivery Perceived health benefit

Costs Direct medical Indirect social

Copyright 1995 Dartmouth Hitchcock Clinic

Clinical Value Compass Worksheet, Side B

SPECIFIC OPERATIONAL DEFINITIONS for key outcome and cost measures

TIPS: Writing Definitions

A conceptual definition is a brief statement describing a variable of interest. It should tell people what you want to measure and who “owns” it.

An operational definition is a clearly specified method for reliably sorting, classifying, or measuring a variable. It should be written as an instruction set, or protocol, that would enable two different people to measure the variable, by using the same process and thereby producing the same result. It should explain to people how a variable should be measured.

Variable name and brief conceptual definition Source of data and operational definition

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